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The Mental Health of Australians 2 3Service Use A key aim of the 2007 survey was to obtain an up-to-date and detailed picture of the health services people use for their mental health problems. This chapter provides information on the characteristics of people who used services in the 12 months prior to interview and the types of health professionals they consulted. The survey collected information on hospital admissions and consultations for mental health problems with a wide range of service providers, including general practitioners; mental health professionals, such as psychologists, psychiatrists and mental health nurses; health professionals not working in mental health services, such as other medical doctors, social workers and nurses; and practitioners of complementary and alternative medicine. Information was also collected on the use of medication for mental health problems. People were also asked if their needs for services were met and, for those who did not use services, whether they needed services, but had not received these. 3.1Service use in the Australian population Overall 11.9% of Australians aged 16-85 years used health services for mental health problems in the previous 12 months. This includes both consultations with health professionals and hospital admissions. A similar proportion of the total population (11.6%) used medications for mental health problems in the previous two weeks prior to the survey. The mental disorder status of service users is shown in Figure 3-1. Of the population using services: • Three–fifths (58.7%) of people who used services had a 12-month mental disorder; • One-fifth (19.8%) had a mental disorder at some point in their lifetime, but did not have symptoms in the previous 12 months; and • One-fifth (21.5%) did not meet lifetime diagnosis for any of the mental disorders assessed in the survey. This last group of people who used services, but who did not have a mental disorder, could also have been doing so for legitimate reasons. People seek help at times of crisis. People also seek help with mental health problems to prevent their escalation or where they are not at a level at which they would be diagnosed with a mental disorder. Others will be receiving treatment for mental disorders not included in the survey, such as the psychotic illnesses. Figure 3‑1: Proportion of people using services for mental health problems in the previous 12 months by mental disorder status Mental disorder in the previous 12 months 58.7% Lifetime mental disorder 19.8% No mental disorder 21.5% 11 The Mental Health of Australians 2 3.2Service use by people with 12-month mental disorders One third (34.9%) of people with 12-month mental disorders used health services for mental health problems in the 12 months prior to interview. This is equivalent to 1.1 million Australians seeking help for their mental health problems during this 12-month period. Hospital admissions constituted a relatively small part of the services used for mental health problems, with 2.6% or just over 80,000 people with 12-month mental disorders reporting at least one hospital admission for a mental health problem in the previous 12 months. 3.2.1 Sex and age profile of service users Service use for mental health problems was higher among females than males. Two‑fifths (40.7%) of females with 12-month mental disorders used services for mental health problems in the previous 12 months compared to just over one quarter (27.5%) of males. Service use was lowest among the youngest and oldest age groups with less than one quarter of people in both age groups having used services for mental health problems in the previous 12 months (23.3% aged 16-34 years and 22.6% aged 75-85 years). For males, service use was lowest among those aged 16-24 years (13.2%), peaked among the 45‑54 year olds with almost two-fifths (38.6%) using services and then declined with age to 19.2% among males aged 75-85 years. For females, service use was also lower in the youngest and oldest age groups, being lowest for females aged 75 to 84 years (24.6%) and slightly higher for females aged 16-24 years (31.2%). Unlike males, service use for females remained above 40% for all other age groups, that is those between 25 and 74 years. The difference in service use between the sexes (Figure 3-2) was greatest for those aged 16-24 years, with females being more than twice as likely to use services compared to males (31.2% in females compared to 13.2% in males). Figure 3‑2: Service use by people with 12-month mental disorders by age and sex 50 40 Service use (%) 12 30 Males 20 Females 10 0 16–24 25–34 35–44 45–54 55–64 65–74 75–85 Age group (years) 3.2.2 Service use by class of mental disorder People who experienced affective disorders in the 12 months prior to interview were more likely than people with anxiety or substance use disorders to access services for their mental health problems (Table 3-1). Over half (58.6%) of all people with affective disorders used services for mental health problems in the 12 months prior to interview. This compares to approximately one third (37.8%) of people with anxiety disorders and one quarter (24.0%) of people with substance use disorders who used services. The Mental Health of Australians 2 Table 3‑1: Service use by 12-month mental disorder class Service use (%) Affective disorders 58.6 Anxiety disorders 37.8 Substance use disorders 24.0 Any mental disorder 34.9 3.2.3 Medication use by mental disorder class One quarter of people (25.3%) with 12-month mental disorders used medications for mental health problems in the two weeks prior to interview (Table 3.2). Similar to service use, medication use was highest for people with affective disorders (42.1%) compared to people with anxiety disorders (28.2%) and substance use disorders (15.8%). Table 3‑2: Medication use for mental health problems by 12-month mental disorder class Medication use (%) Affective disorders 42.1 Anxiety disorders 28.2 Substance use disorders 15.8 Any mental disorder 25.3 3.2.4 Service use by comorbidity of mental disorder classes Comorbidity refers to the occurrence of more than one disorder at the same time. It may refer to co-occurring mental disorders or co-occurring mental and physical disorders. In this section service use is reported for those people with mental disorders from one mental disorder class (affective disorder only, anxiety disorder only and substance use disorder only) and from two or more comorbid mental disorder classes (combinations of affective, anxiety and/or substance use disorders). People experiencing all three classes of mental disorders in the 12 months prior to interview had the highest level of service with two thirds (65.4%) using services in the previous 12 months (Table 3.3). Over half (55.9%) of people experiencing disorders from two classes used services and just over one quarter (27.3%) of people with disorders from only one class of mental disorder used services. Table 3‑3: Service use by comorbidity of 12-month mental disorder classes Service use (%) One mental disorder class 27.3 Two mental disorder classes 55.9 Three mental disorder classes 65.4 Any mental disorder 34.9 13 The Mental Health of Australians 2 Figure 3-3 shows the proportion of people with different combinations of comorbid mental disorders that used services for mental health problems in the 12 months prior to interview. The level of service use was related both to the number of comorbid mental disorders and the class of mental disorders. People with affective disorders only reported higher use of services than people with anxiety disorders only and substance use disorders only (48.8% compared to 27.3% and 11.8% respectively). Service use by people with a combination of affective and anxiety disorders was higher than among people with other combinations of two classes of mental disorder (68.4% compared to 27.8% for affective and substance use disorders and 30.0% for anxiety and substance use disorders). Service use by people with all three classes of disorders was equally high (65.4%). Figure 3‑3: Service use by single and comorbid 12-month mental disorder classes Proportion of peope who used services (%) 14 80 70 60 50 40 30 20 10 0 Affective disorder only Anxiety disorder only Substance use Affective and disorder only anxiety disorders only Affective and Anxiety and Affective, substance use substance use anxiety and disorders only disorders only substance use disorders Mental disorder class 3.2.5 Service use by severity of mental disorders Service use also varied depending on the severity of the mental disorder. Service use was more common among people with more severe disorders. Almost two thirds (64.8%) of people with severe mental disorders used services in the previous 12 months compared to two-fifths (40.2%) of those with moderate mental disorders and less than one-fifth (17.9%) of people with mild mental disorders (Table 3-4). Table 3‑4: Service use by severity of 12-month mental disorders Service use (%) Mild mental disorders 17.9 Moderate mental disorders 40.2 Severe mental disorders 64.8 Any mental disorder 34.9 The same pattern of service use for the various levels of severity was also evident among people with anxiety disorders. However, although service use was highest among people with severe affective disorders (66.1%), it was also relatively high for people with moderate (51.4%) and mild (48.6%) affective disorders (Figure 3-4). Service use was generally lower for those with severe substance use disorders, dropping significantly with lesser severity. The Mental Health of Australians 2 Proportion of peope who used services (%) Figure 3‑4: Service use by 12-month mental disorder class and severity 80 70 60 50 Severe 40 Moderate 30 Mild 20 10 0 Affective disorders Anxiety disorders Mental disorder class 3.3 Substance use disorders People with mental disorders who did not use services The survey not only provided information about who was using services, it also provided information about the characteristics of people who experienced mental disorders in the previous 12 months, but did not use services for their mental health problems. As previously stated, one third (34.9%) of people with 12-month mental disorders used health services for mental health problems in the previous 12 months. Conversely, about two thirds (65.1%) of people with 12-month mental disorders did not use any health services for their mental health problems. Males were much less likely to use services for their mental health problems than females, with nearly three quarters (72.5%) of males with a mental disorder not using services compared to three-fifths (59.3%) of females. Although the prevalence of mental disorders was highest in the younger age groups, service use was low in these groups. Over 80% of males and nearly 70% of females with mental disorders aged 16-24 years do not use any services for their mental health problems. Service use was also low in the older age group. Three quarters (75.5%) of females and four-fifths (80.8%) of males aged 75-85 years did not use services for their mental health problems in the previous 12 months. While service use was more common among people experiencing more severe mental disorders, one third (35.2%) of people experiencing severe disorders and over half (59.8%) of those with moderate disorders did not use services. Moreover, while service use was more common among people with comorbid mental disorders, the survey found that one third (34.6%) of people with 12-month mental disorders from all three disorder classes and almost one half (44.1%) of those with disorders from two classes did not use services in the 12 months prior to interview. 3.4 Perception of need for services The survey examined whether people who had received services or particular types of help over the previous 12 months felt their needs had been met. For people who did not receive services the survey examined whether there were services or types of help that they felt they needed but had not received. The types of help people were asked about were: • information about mental illness, its treatment and available services; • medication; • talking therapy, such as cognitive behaviour therapy, psychotherapy and counselling; • social intervention, such as help to meet people and sort out accommodation or finances; and • skills training to improve the ability to work, self-care or manage time effectively. 15 16 The Mental Health of Australians 2 People with mental disorders who used services generally felt that their needs had been met, especially in the areas of medication (86.7%) and, to a lesser extent, talking therapy (68.2%) (Table 3-5). However, two thirds of people with mental disorders who used services felt that their needs had not been met for skills training (66.0%) and social intervention (68.7%). Table 3‑5: Perception of met need in people with 12-month mental disorders who used services Type of help Needs met (%) Information 56.6 Medication 86.7 Talking therapy 68.2 Social intervention 31.3 Skills training 44.0 There also appeared to be little unmet need in people with mental disorders who did not use services with 85.7% of people reporting that they had no need for any of the types of help asked about in the survey (Table 3-6). Table 3‑6: Perception of need for services in people with 12-month mental disorders who did not use services Type of help No need (%) Information 94.0 Medication 97.4 Talking therapy 89.3 Social intervention 94.1 Skills training 96.2 Any type of help 85.7 3.5Service providers and patterns of service use 3.5.1 Service providers General practitioners were the group of health care professionals most commonly consulted for mental health problems, followed by psychologists. Consultation with both general practitioners and psychologists was highest among people with affective disorders (Table 3-7). As has previously been reported, 34.9% or 1.1 million people with 12-month mental disorders used health services for mental health problems in the previous 12 months. Of this group: • more than two thirds (70.8%) consulted general practitioners; • more than one third (37.7%) consulted psychologists; • almost one quarter (22.7%) consulted psychiatrists; • one-fifth (22.1%) consulted other mental health professionals, who were defined in the survey as mental health nurses and other health professionals working in specialised mental health settings; and • just under one-fifth (18.8%) consulted other health professionals, who include social workers, occupational therapists and counsellors providing general services, medical doctors other than psychiatrists or general practitioners, and practitioners of complementary and alternative medicines. The Mental Health of Australians 2 Table 3‑7: Health professionals consulted by 12-month mental disorder class Affective disorders (%) Anxiety disorders (%) Substance use disorders (%) Any mental disorders (%) General practitioner 78.3 68.5 68.6 70.8 Psychologist 39.6 37.1 37.9 37.7 Psychiatrist 23.5 23.9 24.1 22.7 Other mental health professional 27.3 22.1 37.2 22.1 Other health professional 19.7 19.9 23.7 18.8 Mental health admission 12.3 7.2 17.2 7.5 Note: Columns do not total to 100% as people may have consulted more than one type of health professional. 3.5.2 Patterns of service use Over one quarter (28.9%) of people with 12-month mental disorders received services for their mental health problems from a general practitioner only (Table 3-8). Almost two thirds (64.2%) of people with 12-month mental disorders received services from mental health professionals, either alone or in combination with services provided by general practitioners or other health professionals. Mental health professionals are psychiatrists, psychologists, mental health nurses and other health professionals working in specialised mental health settings. A relatively small proportion (6.1%) of people consulted other health professionals and did not consult a mental health professional. This profile of service use was similar for all classes of mental disorder. Table 3‑8: Patterns of service use by health professional category and 12-month mental disorder class Affective disorders (%) Anxiety disorders (%) Substance use disorders (%) Any mental disorder (%) General practitioner only 29.0 27.4 22.0 28.9 Mental health professionals 65.8 64.9 72.5 64.2 Other health professionals 3.7 6.7 4.0 6.1 Note: Consultations with complementary and alternative therapists are excluded. 17 18 The Mental Health of Australians 2